Transcatheter closure of the atrial septal defect and other cardiac defects: current status (original) (raw)
Related papers
American Heart Journal, 2004
Background: The transcatheter closure of the atrial septal defect (ASD) has become an alternative technique to surgical procedures. The aim of this study was to assess the immediate, short, and intermediate-term results of the transcatheter closure of the secundum ASD with the Amplatzer Septal Occluder (ASO) in adult Iranian patients. Methods: Between December 2004 and July 2008, the transcatheter closure of the ASD using the ASO was attempted in 58 consecutive, adult patients. The mean age of the patients was 37.1 ± 12.7 years (range = 19 -75 years).
Transcatheter Closure of Atrial Communications Using the Amplatzer? Septal Occluder
Journal of Interventional Cardiology, 1999
Certain types of atrial septal defects (ASDs) are amenable for transcatheter closure using various investigational devices. The use of the clamshell or buttoned devices is accompanied with a high incidence of residual shunt. The experience of ASD closure using the AmplatzerrM Septal Occluder (ASO) is limited. Therefore, the purpose of this article is to discuss the protocol of closure and report on the acute results using this device. Nineteen patients ( I 7 ASDL? fenestrated Fontan [FF]) underwent an attempt at catheter closure of their defects at a median age of 13.3 years (range 5.5-67.4 years) and a median weight of 49 kg (range 18-94 kg) using the ASO. The median ASD diameter measured by transesophageal echocardiography (TEE) was 12 mm (range 6-23.8 mm), and the median defect balloon stretched diameter was 17 mm (range 6-31 mm). All ASD patients had right atrial and ventricular volume overload with a mean 5 SD Qp/Qs of 2.4 2 0.9. A 7 to 8Fr catheter was used for delivery of the device in all patients. The device was placed correctly in all but one patient. There were immediate and complete closures (C)
Journal of Interventional Cardiology, 2002
The impact of device size choice on closure results was analyzed in 138 (101 females, 37 males; age 0.5-84.0 years) consecutive patients who underwent transcatheter closure of the secundum atrial septal defect (ASD) using the Amplatzer septal occluder (ASO). The balloon stretched diameter (SD) of ASD was 19.5 2 7.2 mm in 123 patients with single defects, and 20.4 2 6.6 mm for the largest defects in 15 patients with multiple ASDs. The difference ( A ) behveen A S 0 size chosen for closure and the stretched diameter of the defect was calculated and divided into groups: A ( A < -2 mm); B ( A -2.0 to -0. I mm); C ( A = 0); D ( A 0.1-2.0 mm) and E ( A > 2 mm). The results demonstrated that immediate and 24-hour complete closure rates were significantly higher in patients in groups C and D ( P < 0.001). However, at 4-month follow-up, the complete closure rates were similar in patients of groups A-D, while patients of group E had a lower closure rate of 75%. The complication rates were similar in all groups. In conclusion, a choice of a device size identical to or within 2 mm larger than the SD of the defect should be used to maximize the closure rates of ASD using the ASO. (J Interven Cardiol2002; 15287-292) Address for reprints: Ziyad M. Hijazi, M.D., MPH, Section of Pediatric Cardiology, University of Chicago Children's Hospital, 5841 S. Maryland Ave., MC 4051. Chicago, IL 60637. Fax: (773) 834-4 100;
Atrial septal defect (ASD) device trans-catheter closure: limitations
Journal of Thoracic Disease, 2018
Systematic review Transcatheter closure is a widespread technique used to treat secundum atrial septal defects (ASDs). When compared to surgery, it provides a less invasive approach with quicker recovery and reduced physical and psychological impact (1-4). The first case was performed in 1976 by King and Mills (5). However, the percutaneous ASD closure fully entered the clinical arena with the introduction of Amplatzer septal occluder devices (ASO) (6). Since then, many other devices have been developed and used, such as the Gore Cardioform septal occluder (GSO), the Figulla Flexible Occlutech device, the Cardioseal/Starflex and the bio absorbable devices Biostar or Biotrek (7,8). Nowadays, almost 85-90% of all secundum ASD can be closed by using a transcatheter approach (9,10). However, several limitations may have a significant impact on the feasibility and success of percutaneous ASD closure (11,12). Limitations can be grouped as follows: (I) anatomical limitations; (II) device-related limitations; (III) associated defects and natural history associated issues; (IV) physiological limitations; (V) complications. Anatomical limitations A common underlying structure apply to all available devices: they are made of two disks and a connecting segment that keeps them together across the ASD. Two different engineering concepts have been developed, so that occluder devices can be classified as self-centering and nonself-centering ones. The Amplatzer and the Amplatzer-like devices, in which a central connecting waist fills the defect improving stability and occlusion, belong to the former, while devices such as GSO, where the connecting segment is linear, belong to the latter. All the currently available devices need to have surrounding "walls" supporting their stability. In particular, the disks of non-self-centering ones should be 1.8-2 times the diameter of the defect in order to have complete defect closure and avoid mal position or embolization (8). Main anatomical limitations to percutaneous ASD closure may be insufficient surrounding rims, multiple defects and excessively bulging atrial septal aneurisms (ASA). Typical of ostium primum ASD and sinus venosus-type defects, deficiency of surrounding rims can affect ostium
Transcatheter Closure of Atrial Septal Defects
Journal of Interventional Cardiology, 1995
The first transcatheter closure of an atrial septal defect (ASD) was performed by King and Mills in 1976. The Lock Cfunishell occluder and flze hi4ttooned &lice are the latest devices to undergo clitziwl trials. Successful transcaihefer closure hus been possible with minimal morbidity and mortality. Small residual shunts may remain, however. in up to 20% of patients 1 year after the procedure. The clinic-a1 signifc8unce and natural history qf these small residuul atrid commiinirutinns remains to be determined. This article reviews the history and development of the current ASD closure techniques, with emphasis on the experience with the L,ock Clumshell orl-luder and the hitttoned device. (J Interven Cardiol 1995;8:533-542) delivery system in positioning the device parallel to the atrial septum, were additional liabilities of the Rashkind devicc.
Transcatheter device closure of atrial septal defects in patients above age 60
Transcatheter device closure of atrial septal defects guided completely by transthoracic echocardiography: A single cardiac center experience with 152 cases This resulted in better cosmetic results than those by surgical repair. Moreover, our technique was completely guided by transthoracic echocardiography (TTE), thus avoiding X-ray exposure. This study aimed to evaluate the safety and efficacy of our procedure, and the results were found to be encouraging. Methods This study was approved by the Ethics Committee of Fujian Medical University, China, and adhered to the tenets of the Declaration of Helsinki. In addition, written informed consent was obtained from the patients or parents of the patients. All patients who enrolled at our cardiac center between September 2014 and June 2017 were included in the study. They were divided into two groups based on the therapeutic method chosen. Group I included 152 patients (62 males and 90 females) undergoing transcatheter device closure guided completely by Objective: This study aimed to assess the safety and feasibility of transcatheter device closure of atrial septal defects (ASDs) guided completely by transthoracic echocardiography (TTE). Methods: A total of 152 patients underwent transcatheter device closure of ASDs guided completely by TTE in our center from September 2014 to June 2017. We used routine delivery sheaths during the procedure and then closed the ASDs by releasing a domestic occluder. Results: The closure was successful in 150 patients, and surgical repair was required in two patients. The size of the deployed occluder ranged from 10 mm to 38 mm (21.4±8.5 mm), and the procedure duration ranged from 30 to 90 min (38.2±21.4 min). No fatal complications were observed. Minor complications included transient arrhythmias (n=12) during the process of device deployment. The follow-up period was 3 months to 2 years, with no occluder dislodgment, residual fistula, or thrombus-related complications. In our comparative studies, no statistically significant differences were observed in success rates and complications. Conclusion: Transcatheter device closure of ASDs guided completely by TTE may be safe and effective and can be an alternative to traditional methods.
Transcatheter Device Closure of Atrial Septal Defects
Jacc-cardiovascular Interventions, 2013
This review discusses the current safety issues related to U.S. Food and Drug Administration approved atrial septal defect devices and proposes a potential avenue to gather additional safety data including factors, which may be involved in device erosion. Atrial septal defects (ASD) are classified into ostium primum, ostium secundum, sinus venosus, and coronary sinus types. The current reported prevalence of ASD is about 10% of congenital cardiac defects (1). ASD, although recognized as a relatively benign form of cardiac disease, if left untreated can eventually contribute to significant morbidity and mortality, as borne out by the natural history studies (2,3). Unrepaired ASD can lead to right ventricular volume overload with resultant right heart failure, elevated pulmonary vascular resistance, systemic embolism, and atrial arrhythmias. Among the various types of ASDs only the ostium secundum defect is amenable to device closure, whereas all 4 types can be surgically closed. Over the years, routine closure of ASD in childhood has been justified due to the availability of low-risk, curative surgical, and transcatheter options. Transcatheter device closure of secundum ASD is a maturing technology, now more than a decade old. This therapy has become a well-accepted alternative to surgical therapy and has been regarded as generally safe and effective. Widespread use of devices and fairly From the
Pediatric Cardiology, 2009
The Amplatzer septal occluder (ASO) is used for transcatheter closure of atrial septal defects (ASDs). This study aimed to determine the factors influencing successful closure with the ASO. A retrospective analysis of 69 patients who underwent transcatheter ASD occlusion between 2003 and 2007 was performed. The ASO was successfully implanted during 67 (97%) of 69 procedures. A major adverse event occurred for 6 patients (9%), and 13 patients (19%) experienced a minor adverse event. The outcome for 53 cases (77%) was a composite clinical success. Patient age (p = 0.191) and consultant experience (p = 0.270) were not important factors in successful ASD occlusion. However, patient weight (p = 0.031), diameter of the defect (p = 0.030), device size (p = 0.044), aortic rim size (p = 0.002), and device/defect ratio (p \ 0.001) all were significant factors. Complications were significantly more likely for patients whose device/defect ratio was \1.125 (loose) or C1.333 (tight) (p \ 0.001). The device/defect ratio may provide a clinically useful tool with the potential to predict patients likely to experience an adverse event as a result of transcatheter ASD occlusion. A larger sample would enable refinement of the device/defect ratio and provide a more robust prediction of success.
Transcatheter Closure of Congenital Ventricular Septal Defect with Amplatzer Septal Occluders
The American Journal of Cardiology, 2005
This study reports on experience with transcatheter closure of congenital ventricular septal defects (VSDs) with Amplatzer septal occluders. From January 2000 to April 2005, transcatheter Amplatzer device implantation was attempted in 122 patients with congenital VSD (30 with muscular, 87 with perimembranous, and 5 with residual postsurgical repair of conotruncal malformations). Patient mean age was 15 years (range, 6 months to 64 years), and mean weight was 35 kg (range, 5.8 to 102 kg). The VSD mean size was 7 mm (range, 4 to 16 mm), mean Qp/Qs was 2.1 (range, 1.3 to 4), and mean fluoroscopy time was 32 minutes (range, 5 to 129 minutes). All procedures were performed with the patient under general anesthesia and guided by fluoroscopy and transesophageal echocardiography. The device size chosen was usually 1- to 2-mm larger than the maximum defect size as assessed by either the echocardiographic or angiographic views that were judged most reliable. Amplatzer muscular devices were placed in 47 patients, and the membranous devices were placed in 72 patients. The procedure was not performed in 3 patients with perimembranous VSD because of the impossibility of achieving an adequate long sheath position in 1 patient, onset of complete atrioventricular (AV) block during catheter manipulation in 1 patient, and the presence of aortic valve prolapse preventing a safe device placement in 1 patient. Satisfactory device implantation was achieved in 119 of 122 patients (97.5%): a tiny smoke-like residual flow through the device was often seen immediately after the procedure (50%); residual shunting was detectable in 19% after 24 hours and in only 4% at 6 months. The following additional catheter interventions were performed simultaneously: balloon pulmonary valvuloplasty in 3 patients, device closure of atrial septal defects in 2 patients, coil occlusion of the arterial duct in 1 patient, stenting coarctation in 1 patient, and stenting of the right pulmonary artery in 1 patient. Minimal aortic regurgitation developed in 3 patients, and minimal tricuspid regurgitation in 3 patients; no patient required additional treatment. Device embolization occurred in 3 patients (1 patient with muscular VSD, 2 with perimembranous VSD); catheter retrieval and implantation of a second device was successfully performed in all patients. Transient left bundle branch block occurred in 2 patients, and transient first-degree AV block in 1 patient. Among the perimembranous VSD cases, complete AV block occurred acutely (within 48 hours) in 3 patients, requiring a pacemaker in 1 patient; complete heart block occurred in the other 2 patients after 5 and 12 months, requiring pacemakers. There was no mortality. Transcatheter closure of muscular and perimembranous VSDs offers encouraging results: 96% complete closure at midterm follow-up. Complications are limited; the most relevant appears to be device-related complete heart block in perimembranous VSD. Greater experience and long-term follow-up are required to assess the safety and effectiveness of this procedure as an alternative to conventional surgery.
Transcatheter Closure of Atrial Septal Defect
Asian Journal of Medicine and Health, 2021
Background: Over the past decade, percutaneous atrial septal defect (ASD) closure has been the preferred treatment option in many clinical programs for ASD. Percutaneous ASD closures with advanced device architecture and distribution have established user experience and process security. The ability to diagnose has also improved. The devices have evolved from the larger fixtures to the reset zone, being easily eliminated with little residual mesh material and comfortable fitting with the surrounding structures. Biodegradable technology has been introduced and will be considered as a future option. The emergence of the use of the ASD closure device over the last forty years includes improvements that reduce the incidence of adverse effects reported over the years. Issues reported in the literature include thrombus formation, air tightness, device insertion, abrasion, residual shunts and nickel hypersensitivity. Modern tools hold medium and long-term data with excellent results. Multi...